By M. Leon Skolnick
And User's consultant stomach ultrasound examinations at the moment are played ordinarily with real-time instrumentation, thereby giving the person super flexi bility within the demeanour within which the exam is performed. besides the fact that, with such flexibility come major difficulties besides. simply because fields of view are small, and as the operator can simply circulate the probe anyplace within the stomach to work out buildings in a number of planes and sections, it truly is rather effortless to turn into disoriented or to overlook major findings until the exam protocol is care totally devised. The operator needs to strategy the duty of scanning the sufferer in a logical and arranged method that's concerning the patient's medical findings in addition to to the findings stumbled on in the course of the extremely sound exam. This e-book has been written to help the operator in appearing an prepared and directed ultrasound exam by way of offering in define shape a sequential method of the scanning' of belly organs and areas. This process has numerous capabilities: 1) to point the buildings in the organ or sector that are supposed to be scanned; 2) to signify different areas to ascertain if abnormalities in the first and foremost imaged buildings are detected; and three) to signify differential diagnostic percentages while abnormalities are noticeable.
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Extra resources for Guide to the Ultrasound Examination of the Abdomen
5-5] Fig. 5-5 Scan Above And Below Renal Poles eTo detect a superficial renal mass that extends beyond the pole eTo detect a perirenal mass Include Liver Or Spleen eTo compare relative reflectivity of hepatic or splenic parenchyma with that of renal cortex Belly Out/Deep Inspiration Maneuvers eTo cause downward displacement of liver, kidneys, spleen, pancreas, gallbladder below rib cage so as to facilitate scanning. e Belly Out-patient pushes out anterior abdomen by contracting diaphragm [Fig. 5-6] e Deep Inspiration-patient takes deep breath.
Normal • Medullary nephrocalcinosis Cortical echoes appear normal ~ Acoustic shadowing-stones Hyperechoic • Calices Echo-free (fluid-containing) Connected in infundibula More central than pyramids • Renal papillary necrosis Anechoic conical or circular spaces resembling dilated calices that extend into pyramidal regions (cavities in pyramid communicating to collecting system) and replace normal pyramids May see hyperechoic foci in peripheral wall (arcuate artery demarcating furthest extent of pyramid) Dilatation of pelvis not commensurate with size of papillary cavities • Peripelvic cysts Non(,;onnecting anechoic mass(es) Smooth walls/deep echo enhancement May displace perisinusoid or peripelvic fat Distinguish from hydronephrosis Dilated calices,infundibula, and pelvis connect to each other CONSIDER: IVP or CT scan if diagnosis not clear from ultrasound • Medullary cystic disease Multiple, uniform, small, echo-free masses in medullary part of kidney-nonconnecting Increased cortical echogenicity • Hypoechoic focal masses (tumor/abscesslhematoma) Larger than pyramids Round or oval shape Distinguish From 54 Central Echo Complex Normal Appearance Kidney: Native • Hyperechoic region within central part of kidney containing fat, collapsed collecting system, and major vessels Enlarged Central Echo Complex • Peri pelvic lipomatosis Cortical thinning common Enlarged kidney common ~ Shadowing from stones in collecting system CONFIRM by CT-see increased central fat Displacement Of Central Echo Complex • Apparent mass (no pathology) Anatomic variant in configuration Central echo complex appears indented or displaced around mass in one plane, but scan in perpendicular plane shows no mass effect Normal parenchymal echoes within apparent mass Often bilaterally symmetric • True mass-seen in two perpendicular planes Isoechoic with adjacent cortex Column of Berlin Exclude isoechoic tumor CONSIDER: CT or radioisotope scan to distinguish normal cortical tissue from tumor Peripelvic cysts Noncommunicating echo-free mass(es) Smooth walls/deep echo enhancement Distinguish from hydronephrosis-masses communicate with each other CONSIDER: IVP or CT scan if diagnosis not clear from ultrasound Peripelvic lipomatosis Echo-containing mass(es) Confirm with noncontrast CT scan Renal artery aneurysm Echo-free or hypoechoic mass-nonenhancing Walls may shadow-contain calcium May pulsate Show blood flow with Doppler Generalized Dilation Of Collecting System (Hydronephrosis) • Dilated calices, infundibula, pelvis • Dilated ureter-best seen: Adjacent to renal pelvis-proximal segment Posterior to full bladder-distal segment Kidney: Native • Renal pelvic mass Tumor-fixed, nonshadowing Clot/fungal ball-nonshadowing ,/ Movement with change of patient position Appearance may change/disappear over days Stones-shadowing ,/ Mobility with change of patient position • Ureteral obstruction Enlarged para-aortic nodes (usually hypoechoic) Retroperitoneal fibrosis (usually hypoechoic) Distinguish para-aortic mass from food in bowel Apply pressure with probe-bowel collapses, mass remains unchanged • Ureterovesical obstruction Stones at ureterovesical junction ,/ Retrovesical shadowing ,/ Dilated segment of retrovesical ureter Ureterocele ,/Intravesical echo-free mass within full bladder (exclude Foley balloon) • Distended bladder compressing ureters Rescan post voiding If bladder does not empty post voiding.
AJR 136:1075-1079, 1981 11. Jackson VP, Lappas JC: Sonography of the Mirizzi syndrome. J. Ultrasound Med 3:281-283, 1984 12. Jones TB, Dubuisson RL, Hughes JJ, Robinson AE: Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution realtime sonography. J Ultrasound Med 2:345-348, 1983 13. Laing FC, Jeffrey RB: The pseudo-dilated common bile duct: ultrasonographic appearance created by the gallbladder neck. Radiology 135:405-407, 1980 14. Laing FC, Jeffrey RB, Wing VW: Improved visualization of choledocholithiasis by sonography.
Guide to the Ultrasound Examination of the Abdomen by M. Leon Skolnick